Zhang Siying, Li Qinke, Ouyang Xiping, Tang Ya, Cui Ji, Yang Zhu
Department of Gynecology and Obstetrics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Gynecology and Obstetrics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Oncol. 2024 Sep 13;14:1450382. doi: 10.3389/fonc.2024.1450382. eCollection 2024.
To explore the beneficial subgroups after radiotherapy in high-grade neuroendocrine cervical cancer (HGNECC) and construct two survival prognosis models to quantify the efficacy of radiotherapy assessment.
In this retrospective study, we included 592 eligible samples from the Surveillance, Epidemiology, and End Results (SEER) database and 56 patients with lymph-node positive HGNECC from Chongqing Medical University. Cox regression analysis was used to identify independent survival prognosis risk factors for HGNECC patients. Propensity score matching (PSM) was employed as it balances the baseline differences among grouping methods. Kaplan-Meier (K-M) curves were used to analyze survival differences among different groups. Two survival prediction nomograms were constructed separately (using the "rms" package in R software) based on whether radiotherapy was administered. The stability and accuracy of these models were assessed using receiver operating characteristic (ROC) curves and calibration curves in both the training and validation datasets. P<0.05 was considered to indicate statistically significant differences.
Age, Federation of Gynecology and Obstetrics (FIGO)-stage, and treatment methods (surgery vs. chemotherapy) were independent risk factors that affected survival prognosis (P<0.05). Radiotherapy showed adverse effects on survival in patients with early tumor staging, lymph-node negative status, and absence of distant metastasis (all P<0.05). The lymph-node positive group had a beneficial response to radiotherapy (P<0.05), and patients with metastasis in the radiotherapy group showed a survival protection trend (P=0.069).
In HGNECC, patients with lymph-node positive status can benefit from radiotherapy in terms of survival outcomes. We constructed two survival prediction models based on whether radiotherapy was administered, thereby offering a more scientifically guided approach to clinical treatment planning by quantifying the radiotherapy efficacy.
探讨高级别神经内分泌宫颈癌（HGNECC）放疗后的获益亚组，并构建两个生存预后模型以量化放疗评估的疗效。
在这项回顾性研究中，我们纳入了来自监测、流行病学和最终结果（SEER）数据库的592例合格样本以及重庆医科大学的56例淋巴结阳性HGNECC患者。采用Cox回归分析确定HGNECC患者的独立生存预后危险因素。采用倾向评分匹配（PSM）来平衡分组方法之间的基线差异。使用Kaplan-Meier（K-M）曲线分析不同组之间的生存差异。根据是否接受放疗分别构建两个生存预测列线图（使用R软件中的“rms”包）。在训练和验证数据集中，使用受试者工作特征（ROC）曲线和校准曲线评估这些模型的稳定性和准确性。P<0.05被认为具有统计学显著差异。
年龄、国际妇产科联盟（FIGO）分期和治疗方法（手术与化疗）是影响生存预后的独立危险因素（P<0.05）。放疗对肿瘤分期早、淋巴结阴性且无远处转移的患者的生存有不良影响（均P<0.05）。淋巴结阳性组对放疗有良好反应（P<0.05），放疗组中有转移的患者显示出生存保护趋势（P=0.069）。
在HGNECC中，淋巴结阳性患者在生存结局方面可从放疗中获益。我们根据是否接受放疗构建了两个生存预测模型，从而通过量化放疗疗效为临床治疗规划提供更科学的指导方法。
